Scottish Palliative Care Guidelines
- Patients will often report distressed breathing
- They will report increase in distress on lying down.
- Stridor is a sign characterised by a high pitched breathing sound resulting from turbulent air flow
- Consider cause: intrinsic obstructing lesion or extrinsic compression from adjacent structure, for example thyroid.
- If stridor is an anticipated part of disease progression (for example head and neck cancer), prepare the patient and carer and ascertain wishes where possible.
- Ensure wishes are documented in Advance Care Plan/ electronic Key Information Summary
- If tracheostomy is an option arrange emergency admission for definitive procedure to alleviate obstruction
- If tracheostomy is not an option treatment will depend on anticipated prognosis
- If the patient is felt to be imminently dying treat any distress with †midazolam 10mg IV or IM
- Otherwise consider immediate management with corticosteroids with gastroprotection (usually proton pump inhibitor),
- †Dexamethasone 16mg orally (or IV) immediately and subsequently †Dexamethasone 8mg twice daily orally (second dose before 2pm if possible). Discontinue promptly if no benefit and reduce gradually in responders.
- In discussion with senior doctor consider nebulised adrenaline (1:1000) 1mg to 5mg driven on oxygen. Assess response and repeat if necessary.